Feeding practice guidelines for premature infants less than 1500 grams: Efficacy and safety

Abstract

<p>Objectives . To evaluate the efficacy and safety of clinical practice guidelines (CPG) for the nutritional management of very low birth weight infants. Study design and method . A before and after matched cohort study was conducted. During the study periods, 1996/1997 and 1998/1999, data were collected on infants enrolled in the Standard Practice group and CPG group, respectively. CPG were introduced in the neonatal intensive care unit (NICU) in-between these two study periods. Infants <1500 grams admitted to the NICU who had no major congenital anomalies were enrolled. Data on the first 100 babies who could be matched on birth weight (+/- 100 grams), and gestational age (+/- 1 week) were analyzed. Results . There was no statistically significant difference between infants in the Standard Practice and CPG groups in: age when feeds were commenced, time to full feeds, the number of feeding interruptions related to feeding intolerance, days on total parenteral nutrition, days to regain birth weight, or days to discharge from hospital. No significant differences were found in the incidence of sepsis and necrotizing enterocolitis, or use of erythromycin. The difference in the use of cisapride was reflective of a change in unit policy rather than the effect of the implementation of CPG. Conclusions . The findings of this study supported the null hypothesis postulated a priori. Infants may be unresponsive to changes in feeding practices because the state of immaturity of the gastrointestinal system limits the infant's response to such changes. Inconsistent use of CPG may also explain the findings of this study. A more rigorous study design which includes measurements of relative effectiveness of CPG is needed in order to evaluate the utility of the guidelines, process of care, quality of care, and parent/patient satisfaction.</p>